Breastfeeding Pain

By Carly Hill

Talking to some breastfeeding moms, you’ll hear words and phrases thrown around like “easy, natural, relaxing, comforting, and a great way to burn calories.” But, talk to other moms, or that same glowing mom on a bad day and you might hear different words and phrases that are more like, “throbbing, aching, itching, burning, peeling, sore…”

The list goes on.

Breastfeeding should be painless once you get the hang of it, but you’ve got to be patient for the first two weeks of aches and pains and learning to get to that point. 

Some women are lucky enough to avoid the dark side of breastfeeding, but most will, at one point or another, experience some temporary discomfort. 

When you are facing pain of any kind, it’s important to know first, why you are having problems, and next, what you should do about it. 

What Kind of Discomfort Should I EXPECT?

Breastfeeding itself is not painful, but the first few weeks, while your body and baby are getting the hang of things, are usually a little bit uncomfortable.

When you first start out, even if your baby is properly latched on, you might have 30 to 60 seconds of pain, but that should subside after a minute.  If your baby isn’t latching properly, or isn’t getting your nipple deep enough into her mouth, that will cause pain too. But, minor twinges are just part of the learning process and within a week or so, the worst days should be behind you. 

Something else you will feel that first week or so is stomach cramps. Having stomach cramps when you first start breastfeeding is completely normal and completely temporary. Remember, a full-grown baby just left your uterus, so your uterus has some major shrinking to do and it shrinks by contracting, which feels like menstrual cramps. 

What’s amazing about breastfeeding is that it helps to shrink your uterus more quickly; so nursing mothers may have less blood loss after pregnancy and will probably lose weight faster. 

When you feel stomach cramps while nursing, it just means your uterus is shrinking back to its pre-baby size. Hooray! Feel the burn! 

Engorgement Pain is Its Own Thing

Many women give up their attempt at breastfeeding within the first week. They think that because it’s not easy that first week, it won’t ever be easy. But if you can push through the first week or two, breastfeeding will become a walk in the park and a memory you will cherish. 

You can’t go into breastfeeding with the mentality that it will always be as hard as it was the first week. The first week, your breasts are engorged and your body doesn’t know how much milk to produce yet. So, give it time. 

If you haven’t read up on engorgement, you and your partner will be in for quite a surprise. The first few days after you give birth, your breasts may not change much at all. Then, come the third or fourth day, your (probably already huge) breasts will transform into enormous, otherworldly breasts. When your milk is just coming in, your breasts may swell up to three times (yes, 3!) their size. They will be huge. They will be hard. They will be uncomfortable.

They will not stay this way. 

This phase will only last for a few days – a little over a week, tops. To ease your discomfort during the engorgement phase, place some warm washcloths onto your breasts before nursing. After a nursing session, use cold packs and massage gently. This will help a lot, and this soreness will not last. 

Your baby will drain a lot of this milk, and your body will figure out how to meet your particular baby’s needs over the course of the week.

Whatever you do, don’t pump excess milk during that first week. When you pump milk, your body will think your baby needs more, so it will produce even more! Just feed your baby and don’t pump at first and your body will slow down the milk production and tailor it to your baby just perfectly. 

Post-Engorgement Causes of Pain

According to lalecheleague.org, the most common causes of pain during breastfeeding are incorrect positioning at the breast and suction trauma.

These problems can be ironed out with the help of a trained lactation consultant. If your positioning isn’t correct and you don’t seek the help of a lactation consultant soon enough, your nipples can become more easily infected by bacteria or yeast.

If you notice a white dot on the tip of your nipple, it could be a bleb.  A bleb is a white, clear, or yellow milk blister. You can overcome a bleb by using warm compresses and nursing frequently, as strange as that sounds. You’d think that sticking a baby on a tender, hurting organ would be the last thing you should do, but the more you nurse, the better it will feel and the sooner it will heal. 

If you happen to notice a small lump on your breast, you might have a plugged milk duct. The treatment for this is simply hot packs, massaging, and continuing to nurse.

If your nipples hurt when exposed to cold, you may be suffering from nipple vasospasm, or Raynaud’s of the nipple. Your nipple could appear blue or red and blanched. This is a very painful condition. Warm showers and heating pads might help, but you may need to talk to your doctor about taking some anti-inflammatory medication. 

Another cause of tenderness or pain might be a typical skin condition that you’d expect to see on other parts of your body – eczema, psoriasis, and even poison ivy (avoid naked hiking at all costs!). If your breast or nipple skin appears rashy, you might want to check with your doctor and make sure you don’t have some sort of underlying skin condition.

Breasts and nipples can also get sore or tender if you have an allergic reaction to some sort of new shampoo, soap, detergent, medication, or even food that your (older) baby was eating before you started nursing. If you have a mango allergy, for example, and you feed your baby a mango, and then your baby nurses, you could be looking at the problem.

Another possibility is your actual anatomy. If you have inverted or flat nipples (nipples that turn inward rather than protruding out or nipples that don’t become erect when your baby is nursing), you might have a harder time breastfeeding and pain might be frequent. If this is the case, meet with a lactation consultant or doctor who can help you learn some techniques that can make nursing easier on you and your baby.

If you have raw nipples accompanied by shooting or burning pain during or after feedings, or a deep pain within your breast, you may have a yeast infection (otherwise known as thrush). 

Here are some more problems listed by La Leche League that could be causing prolonged pain:

  • Sucking problems
  • A retracted or improperly positioned tongue
  • Strong clenching response
  • Nipple confusion
  • Improper breast pump use

No matter what you think the cause of your pain might be, don’t hesitate to contact your doctor and/or a lactation consultant. One visit with a consultant could save you a lot of pain and all the frustration that comes from trying to self-diagnose.

The bottom line is, nipple soreness and occasional pain is not usually anything to be alarmed about, but any kind of soreness that gets increasingly worse or lasts for more than a week should be a red flag that something is not right. 

If your pain is especially severe and accompanied by fever, redness, red streaks, chills, or any other flu-like symptoms, you might have mastitis or some type of infection, in which case you should contact your doctor right away. But in most all cases, you should be able to continue to nurse. 

When in doubt, call your doctor or consultant. That’s what they’re there for.

Is There a DIY Way to Check if My Positioning is Right?

If you have positioning concerns, refer to the breastfeeding positions portion of this book, but here is a very quick series of questions you can ask yourself to see if you’ve got the basics figured out. This excerpt was taken directly from BreastfeedingBasics.com.

  • The classic cradle hold is the most common nursing position. Sit upright in a comfortable chair, with a pillow supporting your back, one under the arm holding the baby, and another in your lap to bring him up to the level of your breast. You will be spending a lot of time in this position, so make sure that you are comfortable, and are not straining the muscles in your arm, neck, shoulder, or back.
  • Your baby should be positioned on his side, with his whole body facing yours. He should not have to turn his head to reach your breast (try turning your head to one side and swallowing – you’ll be surprised at how difficult it is to do).
  • Cradle his head in the crook of your arm, with his body along your forearm and your hand cupped under his thighs or buttocks. His ear, shoulder, and hip should be in a straight line
  • When you offer your breast, use your free hand to support it with your thumb on top and hand underneath, forming a “C”. Make sure your thumb and fingers are behind the areola (the dark area around the nipple). Gently stroke his lower lip with your nipple – this will encourage him to reflexively open his mouth. Wait for him to open wide, like a yawn, then quickly pull him in close with the arm that is supporting him. Bring him to the breast rather than pushing the breast toward him.
  • His mouth should cover a large portion of the areola (at least an inch). If your areola is large, his mouth may not cover the entire area, but he should be far enough back on the areola so that his gums bypass the nipple and compress the milk sinuses underneath the areola. The nipple should be centered in his mouth, above his tongue. His lower lip should be covering more of the areola than his upper lip.
  • He should be pulled in close so that chin and nose touch your breast. Don’t be afraid that he won’t be able to breathe – that’s why newborns have little pug noses and receding chins. I can’t remember the last time I saw a story in the news about a baby suffocating at his mother’s breast. Can you? If his nose does seem to be blocked, lift your breast or pull him in closer to you. If you press down too firmly on the top of the breast to create an airway, you may pull the nipple to the front of his mouth, which can cause nipple soreness.”

AskDrSears.com has a lot of good advice about breastfeeding and one idea they suggest, if your baby isn’t seeming to take enough nipple tissue in his mouth, is to make what they call a “breast sandwich.”

“Support your breast with fingers underneath, thumb on top, well behind the areola. Press in with your thumb and fingers to flatten the breast while at the same time pushing back toward your chest. This makes the areola longer and narrower and easier for a baby to take into his mouth.”

Here’s another big one – NEVER pop your baby off the breast. If you are trying to take your baby off the breast and you simply pull the baby away, your nipple will hurt for a long time. Always-always-always-always break your baby’s suction by sticking your finger into the corner of his mouth first. Or, you can press down on your breast gently, where the baby has his mouth.

Treatment for Pain

Sometimes, you might experience a little soreness during the beginning of a nursing session, but if you are still in pain throughout the entire feeding, your first step should be to get help from a lactation consultant so you can figure out what’s wrong and how to fix it.

Lactation consultants are so helpful because they will get up close and personal and help you correct any issues you might be having with your technique. Just one visit to a consultant might solve your problem.

In the meantime, don’t be popping any painkillers. Remember, when you take medicine, traces of it go into your breast milk, so don’t ever take anything without consulting your doctor.  The best options you have to soothe your discomfort are warm compresses and warm showers.

If you are just experiencing typical soreness because of engorgement or latching issues, here are some soothing ideas from Whattoexpect.com you can try:

  • Expose your nipples to air briefly after each feeding.
  • Dry your nipples with your hair dryer (set on warm, not hot).
  • Use breast shells to keep your nipples from rubbing against clothing.
  • Express a bit of milk and rub it on the nipple and areola, then leave it to dry to help with cracking.
  • Use medical-grade lanolin-based cream (you’ll likely get some from the hospital) to help with cracking.
  • Slap some wet tea bags on your nipples to relieve soreness (make yourself a cup of tea with them first because you won’t want to do anything but toss them after.)

If nursing is unbearably painful and you have to wait on an appointment with your lactation consultant, you might want to take a one-day break and pump, rather than breastfeed.

Just make sure you don’t stop all nursing/pumping if you plan on nursing long term, because then you risk losing your milk supply. If possible, you’ll want to nurse through the pain.

Despite how it seems, breastfeeding will not slow down the healing process. It has an amazing way of helping things along, on the contrary.

To Nipple Shield or Not To Nipple Shield…

Lactation consultants and nurses are usually hesitant to offer the nipple shield right away. There is a place for a nipple shield, as they can sometimes help protect sore nipples during a feeding or help a baby learn how to go from bottle to breast, but experts don’t love them because they often cause more problems than they solve.

If you’re unfamiliar with the nipple shield, it basically looks like a very thin bottle nipple that you simply stick onto your own nipple before your baby latches on.

This might help some, but it can also cause your baby to become dependent on it (which is a headache) and it may also cause future problems because your baby will have to re-learn latching the natural way.

If you do use a nipple shield, and your lactation consultant recommends it, just do so sparingly.

Preventing Future Pain

Have you ever heard people say that the less you try something, the easier it will be? This can sometimes be true of the overly ambitious new mother. You might get so caught up in doing breastfeeding the “right” way that you won’t give your baby a chance to figure it out on his own.

Babies are wired to self-latch. It’s really frustrating when your baby is hungry and fussy and can’t seem to figure out how to latch on. You might shift and re-shift and not be giving your baby time to orient himself.

Try this. Take a deep breath, relax, and get into a semi-reclining position. Lay your baby tummy-down on your body and just let your baby’s head be near your breast. Just like little baby animals, your baby will naturally bob his little head around and move into a pain-free position on his own.  So, give your baby time to figure it out and be patient.

It’s not always best to run to the rescue and re-situate too soon.

That being said, positioning is very important. Make sure that when you are holding your baby, your nipple is pointed toward his nose, so when he opens his mouth and tips his head back, your nipple will slide into his mouth deeply. Once your baby’s mouth is open, your nipple should be aimed at the roof of his mouth.

Something else to keep in mind is that you want to unlatch your baby as little as possible. Sometimes, your baby might latch on, and you might feel uncomfortable, so your natural instinct will be to stick your finger into the baby’s mouth, unlatch, and try again in a new position.  The problem with this (other than your hungry baby getting frustrated and less cooperative) is that you are risking unnecessary damage to your nipple if the baby has trouble latching on again and you have to go through that process repeatedly.

A better approach might be leaving your baby to drink while you shift your position and attempt to get more comfortable.

When you’re not nursing, air your nipples out. Allowing them to chafe against your bra isn’t going to do you any favors, so as much as possible, let them breathe.

Be cautious about using lanolin or other creams if you’re not sure what is causing your soreness. Any sort of nipple cream could worsen your problem if, for example, you’re dealing with thrush or something like that, rather than just typical soreness. The human body is amazing, and actual breast milk can help heal cracked, bleeding, or blistered nipples.

Just express a little milk onto your nipple and let it air-dry there. Breastfeeding nipples usually heal very quickly if you just keep at it.

Keep Your Chin Up

Remember, breastfeeding pain is temporary and usually ancient history once you’ve gotten through the first 7 to 10 days. But, of course, you may run into problems here and there over the course of your breastfeeding stretch. Don’t get discouraged though. Babies were made to breastfeed, and the breast heals amazingly quickly. It’s own milk heals its wounds and frequent nursing speeds up the healing process. Hang in there!